In other words, the annuloplasty aims to reduce the size of the mitral annulus by shortening the attach of the small valve by means of a kinking, the fulcrum being caught between the commissures. Commissure means a narrowing of the posterior portion perimeter of the mitral annulus by performing thereon kinking with stitches, resulting in a decrease in the antero-posterior and latero-lateral diameter of the mitral valve.
A mitral annuloplasty is performed as correcting means of wich mitral leak mechanism is a dilatation of the mitral annulus (with loss of coaptation of the valvular banks) or, in addition to correcting the leak with another mechanism, (mitral valve prolapse) to increase the coaptation of the posterior mitral valve relative to the anterior mitral valve.
A mitral annuloplasty is a long and tough operation which requires the opening of one of the heart chambers and thoracic cavity with extracorporeal blood circulation.
However, many solutions have been proposed to achieve less invasive annuloplasties, avoiding both a pharmacological cardiac arrest (ischemic) of the heart muscle and extracorporeal circulation. Among known processing devices to perform an annuloplasty, it is possible to use an approach into the left atrium, by retrograde way, that is to say from the femoral artery, or an anterograde approach, that is to say by venous and transeptal way. However, these solutions make laborious to locate the mitral annulus. This results in a relatively large investment of time.
An advantageous solution is the transapical approach, i.e to go directly at the apex of the heart.
Such a solution is described for example in WO 2012/167 095.
Difficulties may also arise for the securing of the prosthetic implant at the native mitral annulus. For example, the securing of the mitral annulus can be done either by self-screwing on the shaft (U.S. 2011/010 6247), or by binding the native mitral annulus to a fabric strip with sutures in the form of hooks.
For a sure fixing as such, that is to say the binding of the prosthetic implant at the mitral annulus, the means being implemented enable to only apply a unilateral force so that we can't exclude the risk of leaks caused by poor fixing.
With these systems, many attempts are very often required to achieve a good fixing.